Iatrogenic rupture of the left main bronchus secondary to repeated surgical lobe torsion during double-lumen tube placement: A case report

Rationale: Bronchial rupture is a rare but potentially life-threatening complication during double-lumen endobronchial tube placement. The rupture of the left main bronchus resulting from repeated surgical torsion is uncommon. Patient concerns: A 70-year-old man with a history of chronic obstructive pulmonary disease (COPD), intermediate emphysema, chronic bronchitis, hypertension, type 2 diabetes mellitus, and L3-L4 lumbar intervertebral disc herniation. Chest x-ray and computed tomography revealed a solitary pulmonary nodule in the left lower lobe. Diagnoses: Left lower lobe carcinoma. Interventions: To improve surgical access, forceps were used to oppress and torque the left lung. Outcomes: An irregular, circular, horizontal, full-thickness rupture of 1.2cm was observed at the tip of the bronchial tube in the left main bronchus upon examination of the bronchial stump. The rupture was repaired via primary suturing with 4-0 prolene thread and secondary reinforcement with a pericardial flap through a left thoracotomy, with no further complications. Lessons: Caution should be exercised during compression and torsion of the pulmonary lobe when attempting to improve surgical access, especially in patients with COPD. Conversion to thoracotomy is recommended if other measures have been unsuccessful.